The Civil War: Hospital hell and battlefield angels

When the Civil War first broke out in 1861, no one thought it would last very long. Thus the North and the South were unprepared to save the wounded. Photo: Civil War surgical chest

VIENNA,Va., March 16, 2012 — Having spent most of the week in a modern, fully equipped and staffed hospital with a family member, my mind turned to what these same facilities would have been like during the Civil War.

To say that they were poorly staffed and equipped is a massive understatement. Antiseptic techniques and sanitary conditions were barely observed and the mortality rate was high.

When the Civil War first broke out in 1861, no one thought it would last very long. The arrogant Northern military assumed they would squash this little ragtag bunch of Rebels quite easily, neglecting to consider that the Southern troops had a high degree of confidence, dedication, and some darn good military officers.  Plus when it is your land being invaded, it tends to give you a double dose of adrenalin and spirit.

Thus with a short fight in mind, even the North had no real ambition to construct and equip field hospitals for a brief battle or two, especially since  at the time it was presumed the South would lie down and roll over. It was not to be.

Civil War field hospital

According to the records, when the war began, the U.S. Surgeon General’s office had 115 surgeons, until 24 of them resigned to create the beginnings of the Confederate medical supply group. At that time, all nurses were men and very few of them had had any kind of training. Everyone has heard of Dorothea Dix, who rushed to Washington to offer her services, but she was rarely allowed any actual independence in which to perform her duties.

Pools of Blood and Limbs

Most descriptions from that period tell of tents with broad tables laid out and the use of triage, which determined which men appeared to be able to survive their injuries and which were, frankly, just not worth wasting precious time and supplies on. Most battlefield physicians had had only two years of college. Many had never seen a gunshot wound, much less one inflicted by a larger weapon.

Doctors were described as having their once white coats covered to the shoulders in blood, of wiping knives or scalpels off on a blood stained cloth, and of piles of amputated arms and legs as high as a man’s shoulder. Sepsis was unknown, making the sites of the hospital tents basically inconsistent with good health procedures, so that surgical areas were filled with harmful bacteria and their resulting toxins. 

Anesthesia was far from a perfected art. Usually a good stiff drink of whiskey, perhaps some chloroform or ether (both discovered about 1846), and a piece of wood clenched between a man’s teeth were all that existed. The old phrase “bite the bullet” probably dates from this time. Even if chloroform or ether were available, quantities were limited.

“We operated in old, blood-stained and often pus-stained coats,” one surgeon remembered. “We used undisinfected instruments from undisinfected pus-lined cases….If a sponge or instrument fell on the floor it was washed and squeezed in a basin of…water as if it were clean.”  Very little had changed, another surgeon opined, from medieval times.

The Shocking Conditions

Clara Barton by Matthew Brady 1865

When those first brave women arrived to be nurses in these hospitals, they immediately grasped why even ill or wounded soldiers tried to stay out of them. Many were just dark, filthy places, and the few men who survived them proved that. The hospitals were frequently placed near latrine lines, and sometimes the same water that fed the latrine also was used for drinking.

Louisa May Alcott, wartime nurse with the North and peacetime author, said that she was literally overwhelmed by “a regiment of the vilest odors that ever assaulted the human nose” when she first began her well-known nursing stint. And a nurse in the Confederate facilities, Kate Cummings, wrote, “Nothing I had ever heard or read had given me the faintest notion of the horrors witnessed here.”

Capt. Sally’s Hospital

In later years of the war there were many nurses on both sides. Capt. Sally Tompkins – the only woman ever commissioned as an officer, was allowed to run a hospital in Richmond, Va. – was a nurse, as were Kate Cummings, Clara Barton, and others. Sally Tompkins’ hospital produced lower mortality rates than the “normal” military hospitals of the day. Phoebe Yates Pember was made Matron/Director of Chimborazo Hospital in Richmond, Va., one of the largest facilities during the war and which was said to have cared for 17,000 injured men.

Some 2,000 women from all across the country put aside their normal protected status in which they had always been confined, and they literally went to war to help the sick and wounded. Names like Louisa May Alcott, Jane Stuart Woolsey, and Katharine Prescott Wormeley will live forever as “Battlefield Angels.”

Captain Sally Tompkins, C.S.A.

Just before the September 17, 1862 Battle of Sharpsburg, Md., also known as Antietam, Pvt. Alexander Hunter of Company A, 17th Virginia Infantry, wrote home, “Another day’s march brought us to Hagerstown where the cornfields and orchards furnished our meals.  The situation, in a sanitary point, was deplorable. Hardly a solder had a whole pair of shoes. Many were absolutely bare-footed, and refused to go to the rear.  The ambulances were filled with the foot-sore and sick.” (From Eyewitness to Battle –NPS Battlefield Guide.) 

Remembering how our own barefoot children have accidentally stepped on nails or briars or splinters brings up the question of tetanus infections, which must have been numerous during the Civil War.

Material for bandages was also scarce. A young woman in Shepherdstown, W. Va., Mary Bedinger Mitchell, wrote “Then there was the hunt for bandages.  Every housekeeper ransacked her stores and brought forth things new and old. I saw one girl, in despair for a strip of cloth, look around helplessly, and then rip off the hem of her white petticoat.”

Eleven Percent of Population Involved

To put the whole war in perspective, at the beginning of the conflict, the entire population of the U.S. was 34 million. If we presume that roughly 50% were women that makes a male population of 17 million as potential soldiers. Yet some 4 million men, or more than 11% of the entire population, were involved in the fighting. 

A majority of those men came from rural settings and lacked any basic immunity to communicable diseases or ailments. They had no experience living in the close quarters endemic to the military, which meant smallpox, malaria, dysentery and measles were rampant. Looking through old muster rolls it is not uncommon to see “went home – measles.” Or to see dysentery as the cause of death. The Confederate soldier could expect to be ill or injured six times during the war, said one authority.

There are few accurate records to indicate exactly how many men perished from wounds and/or illness in the North, and even less in the South where records were incomplete at best and frequently destroyed when found.

Things actually improved a little after the Battle of Sharpsburg in 1862, 22% of the 8,112 who were wounded and treated died. By the time the Battle of Gettysburg (1863) had taken place, only 9% of the 10,569 treated had died. And they died of infection, what we now know as staphylococcus or streptococcus germs, which came from infected amputations and was called “hospital gangrene.”

It was General William Tecumseh Sherman who once said “War is hell.”  Had he spent any or much time in one of the field hospitals, he might have amended that comment to include them: “Our hospitals are hell.”

Follow the column on Face Book or LinkedIn at Martha Boltz, and by email it’s

Read more of Martha’s columns on The Civil War at the Communities at the Washington Times. Follow the column on Face Book or LinkedIn at Martha Boltz, and by email it’s Read more of Martha’s columns on The Civil War at the Communities at the Washington Times.



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Martha M. Boltz

Martha Boltz is a frequent contributor  to the long running Civil War features in The Washington Times America At War feature in the print and online editions. She has been a regular contributor to the original Civil War Page and its successor page since 1994, and is a civil war buff, historian, and writer. "Someone said that if we don't learn about the past, we are condemned to repeat it," she said, "and there are lessons of all sorts inherent in this bloody four-year period of our country's history."  She is a member of several heritage and lineage groups, as well as the Montgomery County Civil War Round Table. Her standing invitation is, "come on down - check the blog - send me your comments and let's have fun with its history and maybe learn something at the same time."


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